Abstract: TH-PO962
Minimal Change Disease in an 82-Year-Old Man with Type 2 Diabetes Without Histologic Evidence of Diabetic Glomerulosclerosis on Renal Biopsy
Session Information
- Glomerular Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Zainaldin, Carl K., Augusta University/Medical College of Georgia, Dunwoody, Georgia, United States
- Mushfiq, Omar, Kidney Clinic of Athens, Athens, Georgia, United States
Introduction
Minimal change disease (MCD) in older adults with type 2 diabetes mellitus (T2DM) is a rare occurrence. Finding MCD in this population without diabetic glomerulosclerosis (DGS) is even more uncommon. We found only 16 reported cases of MCD in the setting of adult type 2 diabetes. Only 4 of those were confirmed to have MCD in the absence of DGS. We report a case of MCD in an 82 year old man with type 2 diabetes whose kidney biopsy showed no histologic evidence of diabetic glomerulosclerosis.
Case Description
An 82 year old man with a 10-year history of T2DM on insulin for 1 year presented with a one week history of lower extremity edema and shortness of breath. On presentation his serum creatinine was 1.4 mg/dl and his serum albumin 2.4 gm/dl. Protein in 24-hour urine was 14 grams. Serology and serum protein electrophoresis were negative. Kidney biopsy was performed. Light microscopy showed normal glomeruli with no evidence of glomerulosclerosis. Electron microscopy revealed diffuse effacement of foot processes diagnostic of minimal change disease. Patient was started on prednisone and achieved complete remission in 5 weeks. At his six-month follow up he was doing well. His creatinine was down to 1.0 and urine protein/creatinine was 0.07 g/g.
Discussion
This case illustrates the value of kidney biopsy in the diagnosis of severe nephrotic syndrome in adults with T2DM. Nephrotic syndrome occurring in a patient with diabetes is often presumed to be due to diabetic glomerulosclerosis and renal biopsy is usually not performed. However, in this patient there were a number of pivot points that suggested further exploration was necessary, including the degree of proteinuria and abruptness of the onset. This case is of clinical significance because MCD in an older diabetic can be easily missed, but if diagnosed, is almost always curable as it was in this patient. Our patient adds to the literature of MCD presenting in older adults with T2DM and provides a new upper age of reported occurrence. It is uncertain as to whether this is a truly rare occurrence or the result of under-reporting because kidney biopsy is infrequently performed in older adults with similar presentation. It is possible that the true incidence of MCD in older adults with T2DM may be less rare than the literature suggests.